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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Hilmi Quraishi and team are building a system to enable adherence to TB treatment. The proposed solution is sliced from ZMQ's Fully-Technology Linked Model (F-TLM) for TB treatment and management called the Open and Universal Technology based TB (OUT-TB) Management and Treatment Framework. The framework was developed by ZMQ under its Freedom TB initiative. The proposed solution empowers the patients with active compliance reporting, gamification, and effective self-management of TB treatment using mobile-based tools integrated with miniature DOTS Center Systems and DOTS Provider Toolkit. The solution is based on a bottom-up technology model, which empowers patients to take control of treatment with reminder systems, compliance reporting, dosage tracking, test scheduling, and provider connection for need-based supervision. The solution will help in creating networks of treated patients as new knowledge providers, who will serve as peer educators to provide assistive support to patients in their communities. The approach will make the treatment a community-lead model.

Janardan Suresh and team are building a mobile-based application to improve TB adherence. The system, called TB Prasakti, involves SMS-based reminder and follow up, automated telephone reminder and follow up, and a total patient information system, which ensures maximum utilization of technology for TB. It provides for easy scalability and affordability and provides a "single window" to capture, store, remind, follow up and generate reports, thus ensuring a comprehensive and all-encompassing solution. The novelty lies in the solution being a total end-to-end tracking of the TB patient treatment and adherence life cycle, in which all the stakeholders are able to communicate through a single system.

Nakul Pasricha and team are working to develop special cards, called myTBdoc cards, with unique alphanumeric identifiers printed on them to be given to medical representatives (MRs). TB medicines manufactured by Lupin will also have unique identifiers printed on them. MRs will give myTBdoc cards to private doctors that see TB patients, educating them on correct TB prescription methods. Doctors will then give these cards to new TB patients, instructing them to SMS the unique code on the card (enrolling them in our program) and to SMS the unique codes printed on their TB drugs as they take them. PharmaSecure will then deliver phone interventions, such as reminders to take medicines, follow up calls, and TB health tips via SMS and voice calls. Lupin holds a major market share in the Indian TB drug market, and hence the solution will reach out to a larger affected population easily.

Krishna Swamy and team are building a comprehensive tuberculosis (TB) mobile application to improve TB detection, treatment, and adherence. The team will build upon its open-source, mobile health (mHealth) platform CommCare and predeployed CommCare mobile applications for TB in India to develop a comprehensive, SMS-enabled mobile application for TB detection, treatment, and adherence. Dimagi will work with the International Union against Tuberculosis and Lung Diseases, South-East Asia (USEA) in the Khunti District, Jharkhand in India to design, test, evaluate, and scale the proposed mDOTS application, which will be designed around the World Health Organization's recommended directly observed treatment, short-course (DOTS) protocol for TB.

Manjari Deb and team are developing a small, electronic pill dispenser called the CoxBox that enables real-time tracking of patient treatment adherence and inventory. The CoxBox innovation provides a relatively inexpensive and easily implementable solution for action-oriented monitoring and controlling of anti-tubercular drug adherence through the use of a microcontroller-based electromechanical pill box with programmable alarm annunciator and a built-in mobile device.

Bill Thies and the team of 99DOTS aim to achieve 99% TB drug adherence using a combination of basic mobile phones and augmented blister packaging to provide real-time medication monitoring at drastically reduced cost. The approach is to utilize a custom envelope, or blister card, into which each pack of medication is inserted and sealed by the care provider. When the patient dispenses medication from the blister pack, the pills also break through perforated flaps on the blister card. On the back side of each flap is a hidden number. Patients submit these numbers using their mobile phone as evidence that they have dispensed medication. To avoid incurring any mobile charges, the numbers are used to complete a phone number and deliver a "Missed call" (Missed calls are free if they are not pointed to a VoiceMail). Using this system patients also receive a series of daily reminders (via SMS and automated calls). Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counseling. Real-time adherence reports are also made available on the web.

This project aims to utilize ultrasound to move and settle human waste collected in a specifically designed latrine. This redesigned latrine uses less water and therefore provides a more sustainable solution to collect human waste.

Anuradha LeleCentre for Development of Advanced ComputingPune, Maharashtra, India

Grand Challenges India

Tuberculosis Treatment

15 Sep 2014

Anuradha Lele and team from CDAC are building an integrated SMS and voice calling solution, which involves mobile-based applications with forms to register patients, a lab form for sputum examinations, IVRS/missed call reminders, and a patient monitoring application for doctors and DOTS workers. The system also plans to include next of kin and friends to enable seamless monitoring of drug intake of the patient.

This project aims to reduce human Zinc deficiency through biofortification by foliar zinc application. It aims to prove that this traditional and efficient strategy of agronomic biofortification, can be a rapid solution for improving zinc concentration in grain to address the ongoing human zinc deficiency.

Lazar Mathew and team are working on a smart pill box that tracks exactly the time through radio frequency identification (RFID) of the dose coupled with SMS trigger systems. The pill box can dispense blister packs rather than tablets, and incorporates a timer which can only be programmed by the medicine provider. Medication cannot be taken out before or after certain times, preventing double dosage. SMS reminders will be sent to family members as well. Monitoring of up to 90 dosages will be possible with a table-top dispenser.

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